Encapsulating peritoneal sclerosis (EPS) is a rare complication of long-term peritoneal dialysis (PD). EPS is associated with extensive thickening and fibrosis of the peritoneum resulting in the formation of a fibrous cocoon encapsulating the bowel leading to intestinal obstruction. The presence of peritoneal thickening, peritoneal calcification and bowel obstruction is considered to be diagnostic of EPS. The current understanding of the pathogenesis of EPS is through the 'two-hit' fibrosis model. This model, however, does not explain the development of peritoneal calcification in patients with EPS. This thesis addresses the hypothesis that altered bone mineral metabolism in ESRF patients together with the mechanical stress of PD influences mesothelial cells to differentiate into osteoblasts promoting calcification in peritoneal tissue. Peritoneal calcification leads to increased tissue stiffness causing progressive fibrosis and the development of EPS. We compared the temporal evolution of the levels of bone mineral markers during PD between patients who developed EPS and control patients on PD. We found that raised serum levels of calcium, phosphate and alkaline phosphatase during PD increased the risk of development of EPS. We compared peritoneum from patients with EPS with that of PD patients without EPS using histological techniques. We found that calcification, organised fibrillary collagen and elastic fibres were significantly more abundant in the EPS peritoneum. Peritoneal calcification was also generalised and distributed not only on the peritoneal surface but also in the sub-mesothelial zone of fibrosis. EPS peritoneum also exhibited osteocalcin, an osteogenic protein, suggesting a cellular mechanism of calcification. Atomic force microscopy of EPS peritoneum showed increased stiffness when compared to control PD peritoneum with the areas of calcification possibly contributing to the increase in tissue stiffness. Human omental cells (HOMCs) were isolated by protease digestion and characterised using a panel of mesothelial markers. HOMCs were cultured in phosphate rich media and phosphate and calcium rich media. HOMCs when cultured with high extracellular levels of calcium showed accelerated mineralisation with upregulation of osteogenic transcription factor runx-2 suggesting osteoblastic transformation. In summary, this thesis indicates that poorly controlled secondary hyperparathyroidism is a risk factor for the development of EPS. On a background of PD related simple sclerosis, uncontrolled secondary hyperparathyroidism can lead to the transformation of mesothelial cells to osteoblasts. This leads to increased matrix deposition and matrix mineralisation causing increased matrix stiffness. Increase in matrix stiffness leads to progressive fibrosis culminating in EPS. Peritoneal calcification can act as the second hit leading to progressive fibrosis and development of EPS.

Resumo: O procedimento de diálise peritoneal é um método de tratamento renal substitutivo muito utilizado na medicina humana. Os trabalhos experimentais em ratos ajudam a compreender as alterações que ocorrem no peritônio, testar novas soluções e aumentar o entendimento sobre os efeitos da diálise na membrana peritoneal. O objetivo deste trabalho foi introduzir o rato como modelo experimental de diálise peritoneal nesta instituição e estudar o efeito da concentração de glicose e da temperatura no peritônio. Foram utilizados ratos Wistar machos. Os ratos receberam injeção intraperitoneal diária por 30 dias com 10ml de fluidos de DP (GSC, glicose 4,25% temperatura ambiente; GSCA, glicose 4,25% aquecida; GSF, solução fisiológica temperatura ambiente; GSFA, solução fisiológica aquecida) e o grupo controle que não recebeu nenhum fluido. No final do experimento foi realizado lavado peritoneal para exame microbiológico e o sacrifício dos animais para colheita de amostras do peritônio para a histomorfologia e a contagem de mastócitos. Na contagem de mastócitos pode-se observar que os animais dos grupos GSC e GSFA apresentavam uma diferença significativa em relação aos animais do grupo controle. Na análise histomorfológica pode-se observar uma alteração significativa do peritônio entre os grupos GSC, GSCA e GSFA quando comparados com o grupo controle. Concluie-se neste estudo que o rato pode ser utilizado como modelo experimental de diálise peritoneal e que a concentração de glicose e a temperatura alteraram a histomorfologia e a contagem de mastócitos do peritônio. / Abstract: The procedure of the peritoneal dialysis is a method of substitutive renal treatment very used in human medicine. The experimental works in rat help to understand the alterations that happen in the peritoneum, to test new solutions and to increase the comprehension on the effects of the dialysis in the membrane peritoneal. The purpose of this work was to introduce the rat as an experimental model of peritoneal dialysis in this institution and to study the effect of the glucose concentration and temperature in the peritoneum. Male Wistar rats were used. The rats received daily intraperitoneal injection for 30 days with 10 ml of fluids the PD (GSC, glucose 4.25 % room temperature; GSCA, glucose 4.25 % heated up; GSF, physiological saline room temperature; GSFA, heated up physiological saline) and the group control that didn't receive any fluid. In the end of the experiment washed peritoneal was accomplished for microbiologic exam and the sacrifice of the animals for crop of samples of the peritoneum for the histomorphology and the mast cells counting. In the mast cells counting it can be observed that the animals of the groups GSC and GSFA presented a significant difference in relation to the animals of the group controls. In the histomorphologic analysis a significant alteration of the peritoneum can be observed among the groups GSC, GSCA and GSFA comparing with the group control. It follows that the rat can be used as experimental model of dialysis peritoneal and the glucose concentration and temperature altered the histomorphology and the mast cells counting in peritoneum. / Orientador: Sônia Regina Verde da Silva Franco / Coorientador: Jacqueline Costa Teixeira Caramori / Banca: Flávio Quaresma Moutinho / Banca: André Luis Balbi / Mestre

Ontario’s Chronic Disease and Prevention Framework (CDPM) is a framework aimed at improving health outcomes and reducing costs. Currently, there is a paucity of data examining diabetes management (DM) in peritoneal dialysis (PD) programs. This study, carried out in 2010-11, describes dietitians’ perspectives regarding DM in PD programs in Ontario. Purposeful sampling of dietitians employed in PD programs (n=18) resulted in a response rate of 86.6%. A web-based survey collected data on demographic characteristics of PD clients, program models, and program-specific data regarding facilitators and barriers to provision of dialysis-specific diabetes education. Statistical analysis was completed and responses to open-ended questions examined using thematic open-coding. Findings suggest three major themes: “walking the CDPM talk”, dietitians as “unrecognized CDPM champions” and “the missing pieces to the CDPM puzzle”. Results suggest that while many dietitians have embraced CDPM, their capacity to fully integrate it into their practices is limited by organizational- and system-level barriers. / UOIT

Despite the decreasing incidence of peritoneal dialysis (PD) peritonitis over time, its occurrence is still associated with adverse outcomes. This thesis focuses on determining factors associated with PD peritonitis in order to facilitate identification of patients at risk. Using data collected in a multicentre Canadian database between 1996 and 2005, the study population comprised 4,247 incident PD patients, of whom 1,605 had at least one peritonitis episode. Variables independently associated with peritonitis included age [rate ratio (RR) 1.04 per decade increase, 95% CI 1.01-1.08], Black race (RR 1.37, 95% CI 1.00-1.88) and having transferred from hemodialysis (RR 1.24, 95% CI 1.11-1.38). There was an interaction between gender and diabetes (p=0.011), with an increased peritonitis risk only among female diabetics (RR 1.27, 95% CI 1.10-1.47). Choice of continuous ambulatory PD vs. automated PD did not influence peritonitis risk. These results contribute to our understanding of peritonitis risk among PD patients.

Despite the decreasing incidence of peritoneal dialysis (PD) peritonitis over time, its occurrence is still associated with adverse outcomes. This thesis focuses on determining factors associated with PD peritonitis in order to facilitate identification of patients at risk. Using data collected in a multicentre Canadian database between 1996 and 2005, the study population comprised 4,247 incident PD patients, of whom 1,605 had at least one peritonitis episode. Variables independently associated with peritonitis included age [rate ratio (RR) 1.04 per decade increase, 95% CI 1.01-1.08], Black race (RR 1.37, 95% CI 1.00-1.88) and having transferred from hemodialysis (RR 1.24, 95% CI 1.11-1.38). There was an interaction between gender and diabetes (p=0.011), with an increased peritonitis risk only among female diabetics (RR 1.27, 95% CI 1.10-1.47). Choice of continuous ambulatory PD vs. automated PD did not influence peritonitis risk. These results contribute to our understanding of peritonitis risk among PD patients.

Thesis (Ph. D.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 199-235).

Thesis (M.Sc. (Clinical Pharmacy))--Mahidol University, 1982.

Thesis (M.S.)--University of Wisconsin--Madison, 1984. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 99-101).

Orientador: Daniela Ponce / Resumo: Introdução: Poucos trabalhos avaliaram a viabilidade e os resultados entre diálise peritoneal (DP) e hemodiálise (HD) no início urgente de terapia renal substitutiva (TRS). Objetivo: Comparar DP e HD como opções de início urgente de TRS, quanto à evolução, desfechos e complicações dos pacientes. Método: Estudo quasi experimental com pacientes incidentes em DP e HD em hospital universitário brasileiro, no período de julho/2014 a dezembro/2016. Incluídos indivíduos DRC estádio final que necessitaram de TRS imediata, ou seja, HD por meio de CVC ou DP cujo cateter foi implantado por nefrologista e utilizado em 72 horas, sem treinamento prévio. Pacientes em DP foram submetidos, inicialmente, a DP de alto volume (DPAV) para compensação metabólica. Após alta hospitalar, permaneciam em DP intermitente na unidade de diálise até efetivação do treinamento. Foram comparados: complicações mecânicas e infecciosas, recuperação de função renal e sobrevida. Resultados: Foram incluídos 93 pacientes em DP (G1) e 91, em HD (G2). Os grupos G1 e G2 foram semelhantes quanto à idade (58+17 vs 60+15; p=0,49), frequência de diabetes mellitus (37,6 vs 50,5%; p=0,10), outras comorbidades (74,1 vs 71,4%; p=0,67) e parâmetros bioquímicos ao início da TRS – creatinina (9,1+4,1 vs 8,0+2,8; p=0,09), albumina sérica (3,1+0,6 vs 3,3+0,6; p=0,06) e hemoglobina (9,5+1,8 vs 9,8+2,0; p=0,44). Após seguimento mínimo de 180 dias e máximo de dois anos, não houve diferença quanto a complicações mecânicas (24,7 vs 37,4... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: Few studies have evaluated the feasibility and results of peritoneal dialysis (PD) and hemodialysis (HD) at the urgent-start of renal replacement therapy (RRT). Objective: We compared PD and HD as options for urgent-start of RRT regarding the evolution, complications and outcomes of patients. Method: End-stage renal disease (ESRD) patients who initiated dialysis urgently without a pre-established functional vascular acess or PD catheter were included in a period between July/2014 to December/2016, from a Brazilian single centre. In urgent-start PD, nephrologists performed the Tenckhoff catheter insertions. It was used high volume PD (HVPD) right after 72 hours PD catheter placement, and it was kept until metabolic and fluid control. After hospital discharge, patients were treated with intermittent PD on alternate days at the dialysis unit, until family training. Results: Ninety-three patients in PD (G1) and 91 in HD (G2) were included. Comparing the G1 group with G2, they were similar in age (58±17 vs 60±15; p= 0.49), frequency of diabetes mellitus (37.6 vs 50.5%; p= 0.10), others comorbidities (74.1 vs 71.4%; p= 0.67) and biochemical parameters to early RRT - creatinine (9.1+4.1 vs 8.0+2.8; p= 0.09), serum albumin (3.1+0.6 vs 3.3+0.6; p= 0.06) and hemoglobin (9.5+1.8 vs 9.8+2.0; p= 0.44). There was no difference between the groups in mechanical complications (24.7 vs 37.4%; p= 0.06) and bacteremia (15 vs 24%; p= 0.11). Exit site infection (ESI) (25.8 vs 39.5%; p ... (Complete abstract click electronic access below) / Doutor

Made available in DSpace on 2014-06-11T19:23:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-11-30Bitstream added on 2014-06-13T19:07:13Z : No. of bitstreams: 1 vicente_pc_me_botfmvz.pdf: 2455776 bytes, checksum: 47e19e0c3e29906b7c443b88d5d54368 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O procedimento de diálise peritoneal é um método de tratamento renal substitutivo muito utilizado na medicina humana. Os trabalhos experimentais em ratos ajudam a compreender as alterações que ocorrem no peritônio, testar novas soluções e aumentar o entendimento sobre os efeitos da diálise na membrana peritoneal. O objetivo deste trabalho foi introduzir o rato como modelo experimental de diálise peritoneal nesta instituição e estudar o efeito da concentração de glicose e da temperatura no peritônio. Foram utilizados ratos Wistar machos. Os ratos receberam injeção intraperitoneal diária por 30 dias com 10ml de fluidos de DP (GSC, glicose 4,25% temperatura ambiente; GSCA, glicose 4,25% aquecida; GSF, solução fisiológica temperatura ambiente; GSFA, solução fisiológica aquecida) e o grupo controle que não recebeu nenhum fluido. No final do experimento foi realizado lavado peritoneal para exame microbiológico e o sacrifício dos animais para colheita de amostras do peritônio para a histomorfologia e a contagem de mastócitos. Na contagem de mastócitos pode-se observar que os animais dos grupos GSC e GSFA apresentavam uma diferença significativa em relação aos animais do grupo controle. Na análise histomorfológica pode-se observar uma alteração significativa do peritônio entre os grupos GSC, GSCA e GSFA quando comparados com o grupo controle. Concluie-se neste estudo que o rato pode ser utilizado como modelo experimental de diálise peritoneal e que a concentração de glicose e a temperatura alteraram a histomorfologia e a contagem de mastócitos do peritônio. / The procedure of the peritoneal dialysis is a method of substitutive renal treatment very used in human medicine. The experimental works in rat help to understand the alterations that happen in the peritoneum, to test new solutions and to increase the comprehension on the effects of the dialysis in the membrane peritoneal. The purpose of this work was to introduce the rat as an experimental model of peritoneal dialysis in this institution and to study the effect of the glucose concentration and temperature in the peritoneum. Male Wistar rats were used. The rats received daily intraperitoneal injection for 30 days with 10 ml of fluids the PD (GSC, glucose 4.25 % room temperature; GSCA, glucose 4.25 % heated up; GSF, physiological saline room temperature; GSFA, heated up physiological saline) and the group control that didn't receive any fluid. In the end of the experiment washed peritoneal was accomplished for microbiologic exam and the sacrifice of the animals for crop of samples of the peritoneum for the histomorphology and the mast cells counting. In the mast cells counting it can be observed that the animals of the groups GSC and GSFA presented a significant difference in relation to the animals of the group controls. In the histomorphologic analysis a significant alteration of the peritoneum can be observed among the groups GSC, GSCA and GSFA comparing with the group control. It follows that the rat can be used as experimental model of dialysis peritoneal and the glucose concentration and temperature altered the histomorphology and the mast cells counting in peritoneum.